Using Occupation to Facilitate Self-Awareness in People who have Acquired Brain Injury: A Pilot Study

Abstract

French

Background. Impaired self-awareness in people who have had an acquired brain injury (ABI) is a complex phenomenon that impedes rehabilitation progress and outcome. Purpose. This pilot study investigated the effect of an occupation-based intervention program on the self-awareness and emotional status of people after ABI. Four male adults with impaired self-awareness following ABI participated in this study. Each received a 10-week individualized program that focused on the performance of three occupations for 1 to 2 hours per week. A facilitative approach was taken, using techniques to improve self-awareness described in the literature. Repeated measures of participants' self-awareness and emotional status were taken pre- and post-intervention, and analyzed descriptively. Results. Results indicated preliminary support for the effectiveness of the program in facilitating participants' self-awareness. However, consideration of baseline and follow-up data indicated a complex picture. Increased anxiety was found to accompany improvements in participants' self-awareness in all four cases. Practice Implications. This study will assist occupational therapists with program development for clients who have had an acquired brain injury.

Keywords

Self-awareness Brain injury Occupational therapy practice

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References

Andersson

Gundersen

P. M.

Finset

(1999). Emotional activation during therapeutic interaction in traumatic brain injury: Effect of apathy, self-awareness and implications for rehabilitation. Brain Injury, 13, 393–404.

Barco

P. P.

Crosson

Bolesta

M. M.

Werts

Stout

(1991). Training awareness and compensation in postacute head injury rehabilitation. In Kreutzer

J. S.

Wehman

P. H.

(Eds.), Cognitive rehabilitation for person's with traumatic brain injury - A functional approach (pp. 129–146). Baltimore: Paul H. Brookes Publishing.

Barnes

G. E.

Prosen

(1984). Depression in Canadian general practice attenders. Canadian Journal of Psychiatry, 29, 2–10.

Bergquist

T. F.

Jacket

M. P.

(1993). Programme methodology: Awareness and goal setting with the traumatically brain injured. Brain Injury, 7, 275–282.

Ben-Yishay

Diller

(1993). Cognitive remediation in traumatic brain injury: Update and issues. Archives of Physical and Medical Rehabilitation, 74, 204–213.

Bieman-Copland

Dywan

(2000). Achieving rehabilitative gains in anosognosia after TBI. Brain and Cognition, 1, 1–18.

Chittum

W. R.

Johnson

Chittum

J. M.

Guercio

J. M.

McMorrow

M. J.

(1996). Road to awareness: An individualised training package for increasing knowledge and comprehension of personal deficits in persons with acquired brain injury. Brain Injury, 10, 763–776.

Cicerone

K. D.

(1989). Psychotherapeutic interventions with traumatically brain-injured patients. Rehabilitation Psychology, 34, 105–114.

Cicerone

K. D.

Dahlberg

Kalmar

Langenbahn

D. M.

Malec

J. F.

Bergquist

T. F.

, (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical and Medical Rehabilitation, 81, 1596–1615. doi:10.1053/apmr.2000.19240

10.

Crosson

Barco

P. P.

Velezo

C. A.

Bolesta

M. M.

Cooper

P. V.

Werts

Brobeck

T. C.

(1989). Awareness of compensation in postacute head injury rehabilitation. Journal of Head Trauma Rehabilitation, 4 (3), 46–54.

11.

DeHope

Finegan

(1999). The self determination model: An approach to develop awareness for survivors of traumatic brain injury. NeuroRehabilitation, 13, 3–12.

12.

Devins

G. M.

Orme

C. M.

(1985). Center for Epidemiologic Studies Depression Scale. In Keyer

D. J.

Sweetlands

R. C.

(Eds.), Test Critiques: Volume two. (pp. 144–160). Kansas City: Westport Publication.

13.

Doig

Fleming

Tooth

(2001). Patterns of community integration 2–5 years post-discharge from brain injury rehabilitation. Brain Injury, 15, 747–762. doi:10.1080/02699050110034343

14.

Ezarchi

Ben-Yishay

Kay

Diller

Rattok

(1991). Predicting employment in traumatic brain injury following neuropsychological rehabilitation. Journal of Head Trauma Rehabilitation, 6 (3), 71–84.

15.

Fleming

Strong

(1995). Self-awareness of deficits following acquired brain injury: Considerations for rehabilitation. British Journal of Occupational Therapy, 58, 55–60.

16.

Fleming

J. M.

Strong

(1997). The development of insight following severe traumatic brain injury: Three case studies. British Journal of Occupational Therapy, 60, 295–300.

17.

Fleming

J. M.

Strong

(1999). A longitudinal study of self-awareness: Functional deficits underestimated by persons with brain injury. Occupational Therapy Journal of Research, 19, 3–17.

18.

Fleming

J. M.

Strong

Ashton

(1996). Self-awareness of deficits in adults with traumatic brain injury: How best to measure? Brain Injury, 10, 1–15.

19.

Fleming

J. M.

Strong

Ashton

(1998). Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationship to outcome. Journal of Head Trauma Rehabilitation, 13 (5), 39–51.

20.

Fleming

Tooth

Connell

Strong

(2002). A comparison of self-awareness and adjustment in adults with traumatic brain injury and spinal cord injury: The transition from hospital to community. Journal of Cognitive Rehabilitation, 20 (3), 28–36.

21.

Fordyce

D. J.

Roueche

J. R.

(1986). Changes in perspectives of disability among patients, staff, and relatives during rehabilitation of brain injury. Rehabilitation Psychology, 31, 217–229.

22.

Giacino

J. T.

Cicerone

K. D.

(1998). Varieties of deficit unawareness after brain injury. Journal of Head Trauma Rehabilitation, 13 (5), 1–15.

23.

Hart

Giovannetti

Montgomery

M. W.

Schwartz

M. F.

(1998). Awareness of errors in naturalistic action after traumatic brain injury. Journal of Head Trauma Rehabilitation, 13 (5), 16–28.

24.

Hendryx

P. M.

(1989). Psychosocial changes perceived by closed-head-injured adults and their families. Archives of Physical and Medical Rehabilitation, 70, 526–530.

25.

Katz

Fleming

Hartman-Maeir

Keren

Lightbody

(2002). Unawareness and/or denial of disability, a dichotomy or continuum: Implications for occupational therapy intervention. Canadian Journal of Occupational Therapy, 69, 281–292.

26.

Katz

Hartman-Maeir

(1997). Occupational performance and metacognition. Canadian Journal of Occupational Therapy, 64, 53–62.

27.

Katz

Hartman-Maeir

(1998). Metacognition: The relationships of awareness and executive functions to occupational performance. In Katz

(Ed.), Cognition and occupation in rehabilitation: Models for intervention in occupational therapy (pp. 323–341). Bethesda MD: American Occupational Therapy Association.

28.

Kielhofner

Forsyth

(1997). The model of human occupation: An overview of current concepts. British Journal of Occupational Therapy, 60, 103–110.

29.

Klonoff

P. S.

O'Brien

K. P.

Prigatano

G. P.

Chiapello

D. A.

Cunningham

(1989). Cognitive retraining after traumatic brain injury and its role in facilitating awareness. Journal of Head Trauma Rehabilitation, 4, (3), 37–45.

30.

Koskinen

(1998). Quality of life 10 years after a very severe traumatic brain injury (TBI): The perspective of the injured and the closest relative. Brain Injury, 12, 631–648. doi:10.1080/026990598122205

31.

Lam

C. S.

McMahon

B. T.

Priddy

D. A.

Gehred-Schultz

M. A.

(1988). Deficit awareness and treatment performance among traumatic head injury adults. Brain Injury, 2, 235–242.

32.

Landa-Gonzalez

(2001). Multicontextual occupational therapy intervention: A case study of traumatic brain injury. Occupational Therapy International, 8, 49–62.

33.

Malec

J. F.

Machulda

M. M.

Moessner

A. M.

(1997). Differing problem perceptions of staff, survivors, and significant others after brain injury. Journal of Head Trauma Rehabilitation, 12 (3), 1–13.

34.

Malia

(1997). Insight after brain injury: What does it mean? The Journal of Cognitive Rehabilitation, 15, (3), 10–16.

35.

Mateer

C. A.

(1999). The rehabilitation of executive disorders. In Stuss

D. T.

Winocur

Robertson

I. H.

(Eds.), Cognitive neurorehabilitation (pp. 314–332). London: Cambridge University Press.

36.

Mazaux

J. M.

Richer

(1998). Rehabilitation after traumatic brain injury in adults. Disability and Rehabilitation, 20, 435–447.

37.

Ownsworth

T. L.

McFarland

Young

(2000). Self-awareness and psychosocial functioning following acquired brain injury: An evaluation of a group support programme. Neuropsychological Rehabilitation, 10, 465–484.

38.

Ownsworth

T. L.

Oei

T. P. S.

(1998). Depression after traumatic brain injury: Conceptualisation and treatment considerations. Brain Injury, 12, 735–751.

39.

Prigatano

G. P.

(1986). Psychotherapy after brain injury. In Prigatano

G. P.

Fordyce

D. J.

Zeiner

H. K.

Roueche

J. R.

Pepping

Wood

B. C.

(Eds.), Neuropsychological rehabilitation after brain injury (pp. 67–95). Baltimore, MD: John Hopkins University Press.

40.

Prigatano

G. P.

(1996). Behavioural limitations TBI patients tend to underestimate: A replication and extension to patients with lateralized cerebral dysfunction. The Clinical Neuropsychologist, 10, 191–201.

41.

Prigatano

G. P.

(1999). Principles of neuropsychological rehabilitation. Oxford: Oxford University Press.

42.

Prigatano

G. P.

Altman

I. M.

O'Brien

K. P.

(1990). Behavioural limitations that traumatic brain-injured patients tend to underestimate. The Clinical Neuropsychologist, 4, 163–176.

43.

Prigatano

G. P.

Fordyce

D. J.

(1986a). Cognitive dysfunction and psychosocial adjustment after brain injury. In Prigatano

G. P.

Fordyce

D. J.

Zeiner

H. K.

Roueche

J. R.

Pepping

Wood

B. C.

(Eds.), Neuropsychological rehabilitation after brain injury (pp. 1–17). Baltimore, MD: John Hopkins University Press.

44.

Prigatano

G. P.

Fordyce

D. J.

(1986b). The neuropsychological rehabilitation program at Presbyterian hospital, Oklahoma City. In Prigatano

G. P.

Fordyce

D. J.

Zeiner

H. K.

Roueche

J. R.

Pepping

Wood

B. C.

(Eds.), Neuropsychological rehabilitation after brain injury (pp. 96–118). Baltimore, MD: John Hopkins University Press.

45.

Prigatano

G. P.

Fordyce

D. J.

Zeiner

H. K.

Roueche

J. R.

Pepping

Wood

B. C.

(Eds.). (1986). Neuropsychological rehabilitation after brain injury. Baltimore, MD: John Hopkins University Press.

46.

Prigatano

G. P.

Klonoff

P. S.

(1998). A clinician's rating scale for evaluating impaired self-awareness and denial of disability after brain injury. The Clinical Neuropsychologist, 12 (1), 56–67.

47.

Prigatano

G. P.

Schacter

D. L.

(1991). Introduction. In Prigatano

G. P.

Schacter

D. L.

(Eds.), Awareness of deficit after brain injury: Clinical and theoretical issues (pp. 3–15). New York: Oxford University Press.

48.

Radloff

L. S.

(1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

49.

Ranseen

J. D.

Bohaska

L. A.

Schmitt

F. A.

(1990). An investigation of anosognosia following traumatic head injury. Clinical Neuropsychology, 12, 29–36.

50.

Rebmann

M. J.

Hannon

(1995). Treatment of unawareness of memory deficits in adults with acquired brain injury: Three case studies. Rehabilitation Psychology, 40, 279–287.

51.

Schacter

D. L.

Glisky

E. L.

McGlynn

S. M.

(1990). Impact of memory disorder on everyday life: Awareness of deficits and return to work. In Tupper

D. E.

Cicerone

K. D.

(Eds.), The neuropsychology of everyday life: Assessment and basic competencies (pp. 231–257). Massachusetts: Kluwer Academic Publishers.

52.

Schlund

M. W.

(1999). Case Study - Self-awareness: Effects of feedback and review on verbal self reports and remembering following brain injury. Brain Injury, 13, 375–380. doi:10.1080/026990599121566

53.

Simmond

Fleming

(2003). Reliability of the Self-Awareness of Deficits Interview for adults with traumatic brain injury. Brain Injury, 17, 325–337. doi:10.1080/0269905021000013219

54.

Sherer

Bergloff

Levin

High

W. M.

Jr. Oden

K. E.

Nick

T. G.

(1998). Impaired awareness and employment outcome after traumatic brain injury. Journal of Head Trauma Rehabilitation, 13 (5), 52–61.

55.

Sherer

Boake

Levin

Silver

B. V.

Ringholz

High

W. M.

Jr. (1998). Characteristics of impaired awareness after traumatic brain injury. Journal of the International Neuropsychological Society, 4, 380–387.

56.

Sherer

Oden

Bergloff

Levin

High

W. M.

Jr. , (1998). Assessment and treatment of impaired awareness after brain injury: implications for community re-integration. NeuroRehabilitation, 10, 25–37.

57.

Toglia

J. P.

(1998). A dynamic interactional model to cognitive rehabilitation. In Katz

(Ed.), Cognition and occupation in rehabilitation: Models for intervention in occupational therapy (pp. 5–50). Bethesda MD: American Occupational Therapy Association.

58.

Toglia

Kirk

(2000). Understanding awareness deficits following brain injury. Neurorehabilitation, 15, 57–70.

59.

Trudel

T. M.

Tryon

W. W.

Purdum

C. M.

(1998). Awareness of disability and long-term outcome after traumatic brain injury. Rehabilitation Psychology, 43, 267–281.

60.

Wallace

C. A.

Bogner

(2000). Awareness of deficits: emotional implications for persons with brain injury and their significant others. Brain Injury, 14, 549–562.

61.

Youngjohn

J. R.

Altman

I. M.

(1989). A performance-based group approach to the treatment of anosognosia and denial. Rehabilitation Psychology, 34, 217–222.

62.

Zhou

Chittum

Johnson

Poppen

Guercio

McMorrow

M. J.

(1996). The utilization of a game format to increase knowledge of residuals among people with acquired brain injury. Journal of Head Trauma Rehabilitation, 11 (1), 51–61.

63.

Zigmond

A. S.

Snaith

R. P.

(1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.